Journal of Advanced Practices in Nursing

Opioids remain the most effective therapeutic agents for the management of moderate to severe pain. A significant number of patients receive long-term opioid therapy for chronic pain. While a number of opioid side effects such as sedation, nausea and vomiting, and respiratory depression diminish over time due to the development of tolerance, the constipating effects of opioid persist throughout the course of therapy. Opioid-induced constipation (OIC) is associated with marked bowel dysfunction that can significantly impact a patient’s quality of life and affect their drug adherence. A step-wise approach to treating OIC should be considered which includes life style modifications, administration of laxatives and stool-softeners, and if necessary, pharmacologic agents to enhance bowel motility and antagonize peripheral μ-opioid receptors. Although OIC is a significant adverse effect associated with opioid use, clinical studies have shown that a number of effective treatment strategies are available for both preventing OIC or reducing its severity.

Background: Elderly population is the most vulnerable population. With the increase in age, there is decline in the body function and eventually the person becomes more prone to health problems.

Objective: To assess the causes and problems of elderly people visiting emergency units of a tertiary care centre.

Methodology: Using purposive sampling technique, 300 subjects with 100 each from emergency medicine, surgery and trauma units were enrolled in the study. Primarily the informants were the patients and in case the patients were not able to communicate, the information was obtained from the caregivers. The socio-demographic profile of the subjects and the physical, social, financial and the organizational setup problems in emergency being faced by them were noted.

Results: Mean age of patients was 68.18 yrs. Maximum admissions in medicine unit were because of cardiovascular problems and in the surgery unit gastrointestinal system problems were predominantly more. However, in trauma unit, 60% subjects were admitted with musculoskeletal problems e.g. fracture of upper and lower limbs. Hypertension was the leading co-morbidity in the subjects of all the three units. After approaching the respective units, 93% subjects in medicine, 83% subjects in surgical unit and 86% subjects in trauma were checked within one hour of their arrival in emergency. A total of 63% in medicine emergency unit, 48% subjects in surgical unit and 99% in trauma unit were not able to maintain their hygiene. In medicine 60% subjects, in surgical unit 59% subjects, however in trauma unit 53% subjects were not able to bear their financial expenses. As per organizational setup problems, insufficient beds and unsatisfactory sitting arrangement for relatives were the main problems reported by majority of the respondents in all the three units.

Conclusion: There is need to develop strategies to make the emergency departments more senior friendly.

Background: After a stroke, patient often suffers varying degree of disability that requires immediate hospital care and extended home care. Therefore, caregivers assume multiple roles to fulfil the needs of survivors at home. The current study aim to explore various needs felt by the caregivers of stroke survivors at home.

Methods: A cross sectional community-based survey was carried out. Hundred participants were enrolled purposively. Modified family needs questionnaire (FNQ) was used to identify the needs of the caregivers. Descriptive statistics was used to analyze the results.

Results: ‘Health information’, ‘Professional support’ and ‘Involvement of care’ sub scales were the most important needs areas of the caregivers. The most important needs were within ‘Health information’, ‘Instrumental support’ and ‘Professional support’ sub scale and least important needs fell within ‘Emotional support’, and ‘Community support’ areas in the caregivers.

Conclusions: Assessment of Family needs amongst the caregivers of individuals with stroke is important for all health care professionals in understanding problems from the caregivers’ perspective. Intervention should be designed and implemented for successful home rehabilitation of stroke survivors.

Constipation is a common symptom in advanced cancer patients. Studies have demonstrated that 40 to 80% of patients on a palliative care service have constipation, this proportion increases to ≥ 90% when patients are treated with opioids. Opioids are very effective analgesics, frequently prescribed in cancer pain, despite proven analgesic efficacy; the use of opioids is commonly associated with frequently dose-limiting constipation that seriously impacts on patients’ quality of life, almost all patients on opioids report constipation as the major side-effect. The aim of this article is to determine the effectiveness of methylnaltrexone and laxatives in the management of opioidinduced constipation among cancer patients in palliative care setting, with focus on randomized clinical trials. A comprehensive and extensive online database search of Science Direct Database, PubMed, Springer Online Database, and HINARI/WHO Database was conducted; also reference lists of related studies were searched, six studies fulfilling the inclusion criteria from 1991 to 2009 were selected and formed the basis for this paper. In three studies the laxatives lactulose, senna, co danthramer, misrakasneham, and magnesium hydroxide with liquid paraffin were evaluated, in three methylnaltrexone. In studies comparing the different laxatives evidence was inconclusive. Evidence on subcutaneous methylnaltrexone was clearer; evidence on laxatives for management of constipation remains limited due to insufficient RCTs. Ultimately it can be suggested from the data presented here that subcutaneous methylnaltrexone is effective in inducing laxation in palliative care patients with opioid-induced constipation and where conventional laxatives have failed.

Having adequate drug information search skills is crucial in order for today’s pharmacists to optimize pharmaceutical care. Howard University College of Pharmacy seeks to better prepare students for this skill by offering a core course entitled, “Drug Informatics”. The purpose of this study was to evaluate the drug information search skills and preferences of the students using a questionnaire. A survey was designed with 18 questions and given to a sample of 65 pharmacy students in their 4th professional year. Data was analyzed by using frequency and Chi square (SPSS) to determine the relationship between students’ demographic and their drug information searching skill or preferences. Survey participation was 48% (31 of 65) with 42% male and 58% female. The most frequently used resources were online databases. Participants who were young or with BA/BS degrees appeared to search more frequently. Most drug information questions received were related to adverse drug events and drug identification. Most participants were confident in their retrieved information and searching skills. The results of this survey will help to improve the design of current drug information coursework.

With the increase in a wide array of medical, behavioral and psychiatric conditions and the belief that chemicals are playing a role in their rise, it is essential that clinicians understand risk factors of toxic chemicals so that they can educate their patients and thus hopefully prevent the occurrence of multiple health concerns. The failure to find any evidence-based reliable and valid tools to assess toxicant exposure and knowledge in the clinician and a patient, it was concluded that while medical science continues to advance on the epidemiology of autism, correlation of toxicant exposure in relation to autism and its treatment lack in the nursing science. There are many implications for practice in advancing the nursing science on toxicant knowledge, exposure, treatment and prevention. In terms of epidemiology, there is a need for more research on identifying the epidemiological contributing factors of autism spectrum disorder.